http://youtu.be/0My7cUQgW_w What are your rights during a RUG Review? It may be an overstatement to say that you have rights as the deck is so stacked against the provider and in favor of the OIG. But, there are a few things to which you are entitled as part of the process of which you should be aware. First, the OIG is required to give you a letter upon entrance into your facility. This is the signal that the review is beginning. The letter will explain the procedures of the … [Read more...] about YOUR RIGHTS DURING A RUG REVIEW
LTC News: Home Health, Hospice
-- "A proposed rule released Thursday would cause home health agencies to experience a 1.5 percent reduction in their Medicare payments for 2014, which the Centers for Medicare & Medicaid Services estimates could reduce payments to these facilities by $290 million next year." - News Medical -- "The Commission on Long-Term Care held its first meeting Thursday [June 28] on Capitol Hill with some members acknowledging that their late start adds to their challenges in offering Congress … [Read more...] about LTC News: Home Health, Hospice
Three Ways to be Prepared for a RUG Review
Your facility will have a RUG review in the near future. Being prepared for a review can be half the battle. Knowing where all your old documentation is and knowing what, exactly, is in that documentation will make a RUG review much easier on the facility. There are three important steps the facility can take to not only mitigate errors found by reviewers, but create a far less stressful review. Organization of old records is the primary key of your preparation. Make sure a minimum … [Read more...] about Three Ways to be Prepared for a RUG Review
CHARTING BY EXCEPTION–THE FAST TRACK TO RUG ERRORS?
Charting by exception is the single most problematic form of nursing charting. Charting by exception is a tool used for residents who require little to no nursing intervention or care. This type of charting, if not done correctly, will leave the facility subject to allegations of RUG review errors. Reviewers scrutinize nurse charting to determine if it supports flow sheets and checklists. Since MDS 3.0 requires clearly documented comments, charting by exception will be a basis for … [Read more...] about CHARTING BY EXCEPTION–THE FAST TRACK TO RUG ERRORS?
RUG REVIEWS: HHSC-OIG reviewers are here – help!
Nursing Homes will be facing a RUG Utilization review in the near future. This review will cover the years from 2008 through 2010 for MDS 2.0 items. What it is and how it works Reviwers select a group of residents from predetermined RUG categories. We have all read how Medicare/Medicaid is going after the therapy RUGs claiming this is the most abused category. However, surveyors are also targeting the ADL RUGs. Any error found for one resident RUG causes the surveyors to … [Read more...] about RUG REVIEWS: HHSC-OIG reviewers are here – help!
TX Register Updates: Anesthesiologist Assistants
The following information was obtained from the May 24 issue of the Texas Register. Public Notice HHSC intends to submit an amendment to the Texas State Plan for Medical that would add Anesthesiologist Assistants to the fee schedules in the current state plan by adding fees for existing services. See the Texas Register for more information. Proposed Rule HHSC proposed new §355.8203, Waiver Payments to Other Performers, which would include a description of eligibility requirements, … [Read more...] about TX Register Updates: Anesthesiologist Assistants
TX Register Updates: Board of Nursing, PASRR Changes
The following information was obtained from the May 17 issue of the Texas Register. Public Notice The Texas Board of Nursing proposed to amend 22 TAC §§213.27, 213.28, 213.29, 213.30, and 213.33, concerning Practice and Procedure: Disciplinary Guidelines for Criminal Conduct (PDF) Proposed Rules HHSC proposed to amend §355.8401, Case Management Reimbursement Methodology, which would update and clarify the methodology used to determine the Medicaid reimbursement rates for providers of … [Read more...] about TX Register Updates: Board of Nursing, PASRR Changes
TX Register Updates: UPL, Medical Board Changes
The following information was obtained from the May 3 issue of the Texas Register. Proposed Rules HHSC proposed to amend §355.105, General Reporting and Documentation Requirements, Methods, and Procedures, which would clarify limitations on reporting related-party compensation on Medicaid cost reports; incorporate changes to reflect person-first respectful language; and clarify the references in subsection (a). See the Texas Register for more information. Adopted Rules HHSC adopted … [Read more...] about TX Register Updates: UPL, Medical Board Changes
TX Register Updates: 5/15 Hearing, Administrative Penalties
The following information was obtained from the April 26 issue of the Texas Register. Public Hearing and Notice HHSC will hold a public hearing on proposed Medicaid payment rates for anesthesiologist assistants on Wednesday, May 15, 2013, at 1:30 p.m. in the HHSC Brown Heatly Building on 4900 North Lamar, Austin. HHSC intends to submit to CMS a request to renew the HCS waiver program. See the Texas Register for more information. Proposed Rules HHSC proposed to amend §354.1003, Time … [Read more...] about TX Register Updates: 5/15 Hearing, Administrative Penalties
LTC News: Convictions, Expansion, and Fraud
CMS recently released a report (PDF) on nursing homes, direct access employees, and criminal convictions. (McKnight's) Providers self-disclosing potential Medicare and Medicaid fraud. (McKnight's) Lawmaker proposes alternative to expanding Medicaid. (Texas Tribune) Hospitals and Medicaid expansion. (Pew) Providers push for whole-treatment payments. (USA Today) … [Read more...] about LTC News: Convictions, Expansion, and Fraud
